An Approach to Diabetes Prevention that Works

Last year, Linda Schoon was staffing a health fair table when a middle-aged woman approached and confided that her doctor had just diagnosed her with prediabetes. Left unchecked, the condition put her at high risk for developing Type 2 diabetes.

“She said, ‘I am so scared. What do I do?’” Schoon recalls.

Schoon, a certified diabetes educator, explained to the woman that changing her fate wasn’t nearly as hard as she might think. On the spot, Schoon did a few calculations and showed her the minimum number of pounds she would have to lose to help ward off diabetes and other complications.

“Her eyes lit up,” Schoon says. “She got really excited.”

The woman turned that excitement into action by enrolling in a local class affiliated with the National Diabetes Prevention Program. The program is recognized by the U.S. Centers for Disease Control and Prevention and run at the local level through partnerships among public and private organizations, such as federal agencies, state and local health departments, employers, insurers and community education programs.

During the yearlong program, a trained lifestyle coach helps participants change behaviors that could put them at higher risk for developing diabetes. They learn about eating healthier, reducing stress and getting more physical activity.

“This is realistic, it’s attainable and it’s sustainable over time.”

The program also provides group support. Participants usually meet once a week during the first six months and then once or twice a month for the rest of the year. Classes are held at churches, health care facilities, gyms. There also is an online option.

More than 84 million U.S. adults — 1 in 3 — have prediabetes, according to the CDC. In general, that means they have blood sugar from 100 to 125 and an A1C (a measure of blood sugar over the previous three months) of 5.7 to 6.4 percent.

People with prediabetes are resistant to their own insulin, so the pancreas produces more of it to keep the blood sugar normal. The pancreas eventually can’t keep up, so the blood sugar rises and the patient is eventually diagnosed with Type 2 diabetes.

“Diabetes is rampant in the American population because we are all gaining weight,” says Dr. Evelyn Lacuesta, an endocrinologist in Chicago and a medical director for Blue Cross and Blue Shield Plans in Illinois, Montana, New Mexico, Oklahoma and Texas. “One of the things we see in our obese population is that prediabetes increases and so does diabetes.”

It’s also expensive for patients and for the health care system. According to the CDC:

The total estimated cost of diagnosed diabetes was $327 billion in 2017. That reflects a 26 percent increase over a five-year period.

Of that cost, $237 billion was direct medical costs and $90 billion was lost productivity.

About 1 in 4 health care dollars is spent on people with diagnosed diabetes.

Medical expenses for people diagnosed with diabetes are about 2.3 times higher than for people without diabetes.

The good news is that following a program like the CDC’s may lessen the chance of developing diabetes.

The Blues Plans in Illinois, Montana, New Mexico, Oklahoma and Texas are providing Medicare Advantage members access to these diabetes prevention programs. The Blues Plans also have diabetes prevention programs for members covered by their employers and those with individual coverage, using a combination of active care management and education.

The CDC’s program is based on research led by the National Institutes of Health, which showed that people with prediabetes who participated in a structured program like the National Diabetes Prevention Program cut their risk of developing Type 2 diabetes by 58 percent.

The study looked at programs that help people lose 5 to 7 percent of their body weight through healthier eating and get 150 minutes of physical activity a week. A follow-up study found that a decade later, people who completed a lifestyle change program were one-third less likely to develop Type 2 diabetes.

“If you go to the doctor and you have prediabetes, you can take action to prevent diabetes,” says Angela Forfia, senior manager of prevention for the American Association of Diabetes Educators. “And it isn’t like you have to lose 100 pounds, do a triathlon or get back to your college pants size. It’s modest weight loss and 150 minutes of walking a week. This is realistic, it’s attainable and it’s sustainable over time.”

For older people, the results are even more promising. Those older than 60 cut their risk of developing Type 2 diabetes by 71 percent after participating in a National Diabetes Prevention Program. This success led the Centers for Medicare and Medicaid Services to expand its pilot diabetes prevention program to fully cover all eligible at-risk beneficiaries age 65 and older.

This is significant because of the 84 million people with diabetes, 22 million are older than 65, Forfia says.

“This is really historic, from our perspective, that Medicare is covering prediabetes education with no co-pay,” Forfia says. “CMS really looked at it from the lens of return on investment and found they would save more than $2,650 per person in health care costs if they enrolled someone in the program who was at risk for developing Type 2 diabetes.”

Even with a good prevention program in place, Lacuesta says some people may not avoid developing Type 2 diabetes. Some may be too far along or have too strong of a genetic component to avoid it. And others, she says, are unable to make the changes they know they need to make.

“You have to have a motivated patient,” she says. “If the patient isn’t motivated, you can talk until you’re blue in the face and nothing is going to happen. They have to be motivated to make it happen.”

After a year of attending the Diabetes Prevention Program in northern Colorado, the woman who met Schoon at the health fair lost 12 percent of her body weight and has kept it off. She is eating out less and shopping at farmers markets to make fresh salads and soups. Her blood test numbers — glucose and A1C — were no longer in the prediabetes range.

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